1. Menstrual hygiene management: the basics

2. Introduction
What are menstruation and menstrual hygiene management (MHM)?
Challenges faced by girls and women
MHM and health
Key components of MHM
Inclusive MHM
Cross-sectoral roles
Menstrual hygiene matters resource book

3. What is menstruation?
A natural bodily function and vital sign of good reproductive health
Girls typically start to menstruate between ten and 18 years old
Results in bleeding from womb (uterus) and through the vagina
Usually occurs monthly for between two to seven days
Average amount of blood lost is ml – some lighter flow and some heavier flow days
Picture: Kanyemba A (2011) Growing up at school, a guide to menstrual management for school girls. Zimbabwe: Water Research Commission, South Africa.

4. The menstrual cycle Days Process 1-7: menstruation
8-11: tissue and blood
line the walls of the
uterus
12-15: ovulation
16-25: lining of uterus dissolves
(if the egg is not fertilised)
26-28: the lining detaches,
leading to menstruation
Approx. every 28 days but may be
May be irregular, especially in first 1-2 years
Picture: Based on UNICEF (no date) Flow with it, babe! Let’s talk about feminine hygiene. East Africa.

5. Menstruation is a vital sign of health
It is a natural process and a vital sign of the healthy reproductive cycle of women and girls.
It is not a sickness but women and girls may suffer from abdominal pains, nausea, tiredness, headache, back ache or discomfort.
Women and girls may also have feelings of sadness or irritation due to hormonal changes.
These experiences vary from person to person and over time.

6. Menstrual hygiene definition
Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials.
They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.
Drafted by JMP Hygiene Working Group, 2012

7. Challenges faced by girls and women
Lack of sanitary protection materials
– leading to embarrassment and stress due to leakage and smell
Lack of menstrual hygiene-friendly facilities
– so unable to change materials and wash, leading to absence from school or work
Fear of using the latrine
– due to staining or lack of privacy or unsafe location

8. Excluded from WASH facilities
In some communities, women and girls are not allowed to use water sources during menstruation.
In communities in Gujarat, India, 91% of girls reported staying away from flowing water.
In a study in South Asia, 20% of the women interviewed, who had access to toilets, did not use them during their periods, partly due to fear of staining the toilet.

9. Challenges faced by girls and women
Less concentration and participation
– including standing up to answer questions at school, due to worries about leakage or pain
Lack of knowledge
– leading to fear, embarrassment and unhygienic practices
Exclusion from daily activities
– due to discomfort, concern over leakage or cultural restrictions

10. Lack of knowledge, guidance and support
“I didn’t know what was happening or what to do to manage menstruation. I used cotton wool, pages from an exercise book, leaves from trees. I suffered much embarrassment at school because I leaked and stained my uniform.” Woman, Tanzania “Guidance and support at school is more important than anything. There is nobody to talk to. When we have problems we just run from class and go home.” Student, Malawi

11. Excluded from home
“The gods get angry if we enter the house during menstruation. I don´t worry about myself but I can´t sleep properly when my daughter is in chhaupadi, vulnerable to snakes and the freezing cold.” Woman, Nepal

12. Menstrual hygiene and health
Limited evidence on actual health impacts, but plausible link with poor menstrual hygiene.
Distinction between menstrual disorders and health conditions associated with poor menstrual hygiene.
Menstrual hygiene may be a greater challenge for those suffering incontinence, fistula or female genital mutilation.

13. What is health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
World Health Organization (1948)

14. Breaking the chain of silence
Women and girls’ lack of involvement in decision making
Lack of information and awareness
Lack of access to products and facilities
Lack of social support

15. Menstrual hygiene requires
access to accurate and pragmatic information
access to menstrual hygiene materials
access to facilities that provide privacy
access to water and soap within a place that provides an adequate level of privacy
access to disposal facilities for used menstrual materials

16. Pragmatic information
Pictures and photo (clockwise from left): WaterAid; Sommer M; UNICEF; Tridhara Photography/ Anisur Rahman

17. MHM-friendly WASH facilities
Latrine design Bangladesh
Wider chamber
Washing platform and water inside cubicle
Rail for drying/hanging cloths
Disposal?
Photo: WaterAid

18. MHM-friendly WASH facilities
School latrine design India
Water inside the latrine
Integrated incinerator
Disposal bin
Photo: WaterAid

19. Sanitary materials, supply, and disposal
Pictures and photo (left to right):
AFRIpads; Tridhara Photography/ Anisur Rahman; WaterAid

20. All girls and women are not the same
Culture, language, religion
Household context
Living in institutions
Age and maturity
Differently-abled
Especially vulnerable or marginalised circumstances
Photo: WaterAid/ Caroline Irby

21. Vulnerable and marginalised contexts
Photo: WaterAid/ Therese Mahon

22. Challenges faced by girls with disabilities
Less access to facilities, materials and information
Unable to see leaks or extent of blood
Have to sit on dirty latrine to change pads or cloths
May need support to change their pads or cloths
Cannot communicate their pain or discomfort and may have heightened sensitivity
Illustration: IASC WASH Cluster Visual Aids Library

23. Sector roles WASH Health Education Gender Private sector
Social protection
Photo: Tridhara Photography/ Anisur Rahman

24. Menstrual hygiene matters: a practical and comprehensive resource
Photos: Tridhara Photography/ Anisur Rahman; Moto Michikata

25. Menstrual hygiene matters training guide and resource book available for download at: